United States onlyMedica is a nonprofit health plan that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. The Utilization Review III position is responsible for reviewing, investigating, and resolving member and provider appeals and grievances requiring clinical expertise.
Requirements
- Conduct clinical review of member and provider appeals
- Evaluate medical necessity, appropriateness of care, and benefit coverage using clinical guidelines and evidence-based criteria
- Investigate grievances by reviewing medical records, claims, and related documentation
Benefits
- Competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits
